Patients undergoing surgery often experience a loss of control, feeling more like victims than participants. Anxiety, fear of the unknown, fear of pain, dependency, uncertainty, and helplessness are common emotions which can intensify the perception of pain associated with invasive medical procedures.

Physical and psychological stress can also contribute to prolonged postoperative recovery and a suppressed immune system.

To help retain a sense of control, patients can learn a range of positive skills including imagery, relaxation, self-talk, and positive outcome expectations.

Guided imagery is a technique that draws on the power of thought to influence psychological and physiological states. The patient listens to an audio tape to create mental images that bring about a state of focused concentration. This state, in turn, allows relaxation and produces a sense of physical and emotional well-being. Patients can use this technique to control their reactions to anxiety, depression, and stressful situations.

Guided imagery may also help patients strengthen their immune system and enhance their own healing.

A recent study at the Cleveland Clinic Foundation investigated the effect of guided imagery on 130 patients undergoing colorectal surgery. A control group received standard surgical care. Another group listened to a guided imagery tape to help them become calm and focused.

The guided imagery tape included soft, soothing music, and a story that brought patients to a "special place" in their mind - a place that was safe, secure, protected, supported, and relaxed. The imagery story encouraged patients to confront and work through any feelings of fear, anxiety, and negativity.

Patients were instructed to listen to the tape without interruption twice per day, once in the morning and once in evening, for three days before the operation and for six days after. During surgery and in the recovery room they listened to a tape with only the music.

Those who listened to guided imagery tapes fared much better--both before and after surgery. Before surgery, anxiety increased in the control group but decreased in the guided imagery group. After surgery, pain and anxiety levels were significantly lower for the imagery patients. They needed only about half the amount of narcotic pain medications as the control group and their bowel function also returned much more quickly.

The number of patients experiencing postoperative complications such as nausea, vomiting, or disrupted bowel function did not differ significantly in the two groups. Nor were there enough participants to detect a statistically significant difference in length of hospital stay.

But virtually all of the guided imagery patients reported that they appreciated using the tapes and attributed benefits including improved quality of sleep, speeded recovery, and reduced anxiety and pain after surgery. Most believed that all patients having major abdominal surgery should have the opportunity to use the guided imagery tapes.

How do the guided imagery tapes improve the surgical experience? The answer is not clear at this point. Using the tapes may increase patients' sense of control and active participation, which in turn may reduce anxiety and change physiology. Music has been shown to influence mood and, perhaps, immune function. The tapes also provide a temporary escape, blocking out annoying noises, and distracting the patients from pain and anxious thoughts.

Guided imagery can help you relax, clear your mind, and engage physiologically and psychologically supportive images. Of course, you don't have to be facing surgery to enjoy these benefits. Imagery tapes can be used for general relaxation and stress reduction as well as management of a variety of diseases.

David S. Sobel, M.D., M.P.H., is a practicing physician in adult medicine and Medical Director of Patient Education and Health Promotion for Kaiser Permanente Northern California. He is physician lead for the......more

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